1/29. Intra-hepatic haematoma complicating transjugular intra-hepatic portosystemic shunt for budd-chiari syndrome associated with anti-phospholipid antibodies, aplastic anaemia and chronic hepatitis c.Portal venous decompression with transjugular intra-hepatic portosystemic shunt (TIPS) is a new approach in the treatment of budd-chiari syndrome. We report on a 31-year-old female with budd-chiari syndrome due to anti-phospholipid antibodies with compression of the inferior vena cava treated with TIPS and stenting of the inferior vena cava. TIPS was complicated by massive intra-hepatic haematoma which was managed conservatively. Treatment options and pathogenic mechanisms of budd-chiari syndrome under the rare coincidence of aplastic anaemia and anti-phospholipid syndrome are discussed. TIPS may be considered for venous decompression in budd-chiari syndrome, but physicians should be aware of potential TIPS' complications in these patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/29. enoxaparin associated with hugh abdominal wall hematomas: a report of two cases.enoxaparin is a low-molecular-weight heparin used for prophylaxis against deep venous thrombosis. Indications include hip and knee replacement surgery, risk of deep venous thrombosis during abdominal surgery, and prevention of ischemic complications of unstable angina and non-Q-wave myocardial infarction. Its efficacy in the prevention of the above complications has been previously studied; however, the liberal use of enoxaparin is not without incident. Complications of enoxaparin include hemorrhage, thrombocytopenia, and local reactions. Since 1993 there have been more than 40 reports of epidural or spinal hematoma formation with the concurrent use of enoxaparin and spinal/epidural anesthesia or spinal puncture. Herein reported are two cases of abdominal wall hematomas in patients receiving prophylaxis with enoxaparin. Both patients sustained an unexplained fall in the hematocrit and abdominal pain. A CT scan confirmed the diagnosis. One patient recovered uneventfully; however, the other patient, on chronic hemodialysis, became hemodynamically unstable and hyperkalemic and sustained a fatal cardiac arrhythmia. An extensive review of the literature revealed no similar cases of abdominal wall hematomas associated with enoxaparin although other complications, including spinal and epidural hematomas, psoas hematomas, and skin necrosis have been reported. The extended use of enoxaparin as an anticoagulant requires the physician to be vigilant of these rare complications. Bleeding can occur at any site during therapy with enoxaparin. An unexplained fall in the hematocrit or blood pressure should lead to a search for a bleeding site.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/29. Serial bedside emergency ultrasound in a case of pediatric blunt abdominal trauma with severe abdominal pain.We present a case of a teenager with isolated left renal laceration with perirenal hematoma. The patient had presented with severe left upper quadrant (LUQ) pain following blunt abdominal trauma (BAT) sustained during a sledding accident. A screening bedside focused abdominal sonogram for trauma (FAST) rapidly excluded free fluid on two serial examinations, 30 minutes apart. It provided the pediatric emergency physician with a measure of diagnostic confidence that the patient could be safely transported to the CT suite for detailed delineation of his injury. Moreover, narcotic analgesia was liberally administered early in his illness course, without the fear of unmasking potential hypovolemia when it was known that he did not have gross intra-abdominal bleeding on his bedside ultrasound (US). It also provided a working diagnosis of the primary organ of injury. Our hospital, like many pediatric hospitals around the nation, does not have in-house 24-hour radiology support. We suggest that the use of the bedside US be extended to the stable pediatric patient in severe abdominal pain following BAT. It can serve as a valuable, rapid, noninvasive, bedside, easily repeated, fairly accurate triage tool to evaluate pediatric BAT with severe pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/29. Spontaneously infected cephalohematoma: case report and review of the literature.Spontaneously infected cephalohematomas are rare occurrences; only five cases have been reported previously. Uninfected cephalohematomas are common and usually resolve without treatment. However, physicians should be aware that cephalohematomas are potential sites for infection and may require aspiration for diagnosis and treatment. Untreated infected cephalohematomas may lead to osteomyelitis, epidural abscess, or subdural empyema. We present a case of a spontaneously infected cephalohematoma with an associated osteomyelitis which was successfully managed with drainage and long-term antibiotics. A review of the literature is also presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/29. An unusual cause of pelvic mass.BACKGROUND: pelvic pain with an associated pelvic mass is a common problem in the emergency room (ER) or physician's office. Concerns about ectopic pregnancy, infection, or malignancy usually dominate the diagnostic evaluation. At the same time, domestic violence as the cause of a pelvic mass is seldom suspected by physicians. CASE: A 38-year-old woman came to the ER with left lower quadrant pain and a left pelvic mass. After four hospital days and multiple diagnostic imaging studies, the diagnosis of hematoma caused by physical trauma to the abdomen was elucidated. CONCLUSION: Proper diagnosis of the cause of the pelvic mass could have been made earlier by careful attention to the social history and by recognizing the high incidence of domestic violence as opposed to the relative infrequency of some other diagnostic entities for which the patient was tested.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
6/29. Recurrent haemoperitoneum in a mild von Willebrand's disease combined with a storage pool deficit.Haemoperitoneum secondary to haemorrhagic corpus luteum has been described in severe bleeding disorders such as afibrinogenaemia, type 3 von Willebrand's disease and patients under oral anticoagulation. We have studied one patient who presented three episodes of severe bleeding at ovulation, requiring surgery twice, with the diagnosis of mild von Willebrand's disease and mild storage pool deficiency. Mild von Willebrand's disease (associated with other thrombopathies or coagulopathies) should be considered in this pathology, although physicians would prefer to find a severe haemorrhagic disorder as the underlying condition in these cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/29. Craniofacial trauma in children.Craniofacial trauma is relatively uncommon in children, but the potential involvement of the structures at the base of the skull and the intracranial space makes it important for physicians to understand the potential dangers presented by such injuries. This report delineates the different types of injury that can damage the upper facial skeleton and the brain of a child. The author reviews initial management and diagnosis of such injuries and examines the approach to definitive reconstructive surgery using three case studies as examples for discussion.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/29. leiomyosarcoma presenting as a spontaneously ruptured renal tumor-case report.BACKGROUND: Ruptured renal neoplasms can be a catastrophic clinical presentation. angiomyolipoma is the commonest renal tumor which presents in this fashion. Renal sarcomas are rare renal neoplasms. Renal leiomyosarcomas are the most common histological subtype of renal sarcomas, accounting for approximately 50-60% of the reported cases. These tumors are usually peripherally located and appear to arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall. CASE PRESENTATION: A 70 years old male, with hypertension and ischemic disease, developed acute left flank pain. The general physician evaluated this using ultrasound, which showed a solid left renal mass. Two weeks later, he presented in the emergency room in a state of shock with a palpable flank mass. CT scan of the abdomen showed a large heterogeneous mass lesion in the left perinephric space with minimal post contrast enhancement. Per-operatively, large retroperitoneal hematoma was found within Gerota's fascia along with spleen plastered to the upper limit of hematoma. nephrectomy and splenectomy were performed. Postoperative course was uneventful and patient was discharged on the 10th post-operative day. Histopathological evaluation of the specimen showed high-grade leiomyosarcoma CONCLUSIONS: Spontaneous rupture of renal neoplasm is a rare clinical presentation. angiomyolipoma is the commonest cause of spontaneous rupture of the kidney. Presentation of a leimyosarcoma as a ruptured renal neoplasm has not been previously reported in the English literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/29. Case of sublingual hematoma threatening airway obstruction.BACKGROUND: The complications of warfarin therapy have classically been described as bleeding in the genitourinary and gastrointestinal tracts, skin, central nervous system, nose, penis, or retroperitoneum. However, rarely warfarin may cause bleeding that compromises a patient's airway. A sublingual haematoma is an example of such a complication. Only 10 previous cases of sublingual haematomas have been reported. CASE REPORT: We describe the case of a 56 year-old woman receiving oral anticoagulation who presented with a sore throat and hoarseness. Examination of her oral cavity revealed a soft, red, submucosal swelling involving the floor of mouth and ventral lingual surface bilaterally. No signs of airway compromise were observed. The patient's PT-INR was 10. Given the potential for rapid airway obstruction, the patient was admitted to a unit with closely monitored beds. Her coagulation disturbance was corrected medically and her haematoma resolved. The patient was discharged to the care of her family physician. CONCLUSIONS: This case makes several important points. First, the case describes a rare, but life-threatening complication of warfarin therapy. Second, the initial signs of a sublingual haematoma are reviewed. Given the vagueness of these signs, diagnosis requires a high index of suspicion on the part of the physician. Finally, the case describes successfully management of this disorder without the use of a surgical airway. For this patient, reversal of her anticoagulation and vigilant monitoring saved her from having a surgical airway placed.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
10/29. Intraspinal hematomas in hemophilia.We report herein a case of a intraspinal hematoma in a 9-year-old boy with factor ix deficiency. Replacement of factor ix resulted in resolution of symptoms. The most frequent presentations of intraspinal hematomas are neck or back pain, paresis, sensory impairment, and urinary retention. Intraspinal hematomas may have devastating sequelae, including hemiplegia and quadriplegia. The occurrence or development of sequelae are related to the length of time between onset of symptoms and factor replacement. Whenever the physician suspects intraspinal hematoma, immediate replacement should be given to obtain levels of 80-100% prior to any imaging studies. Factor levels should be maintained at 30-50% for 10-14 days while the patient is monitored closely with serial neurological examinations. Most patients respond to factor replacement, but laminectomy should be considered for intractable or progressive cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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